Background. Routine closed suction drainage and postoperative laboratory studies have long been tenets of most TJA protocols. However, recent literature has called into question whether either is necessary with modern outpatient TJA clinical pathways. Methods. Demographic, cost, and readmission data for 2,605 primary unilateral TJA cases was collected retrospectively and analyzed prior to and after a protocol change where routine closed suction drains and postoperative laboratory tests were eliminated. This protocol change was designed to treat all primary TJA like outpatients regardless of their admission status. Drain usage changed from routine to selective based on hemostasis. Lab studies changed from routine to selective for patients on warfarin for VTE prophylaxis (INR), with ASA 4 or 5 status (BMP), and with a hematocrit < 27% in the recovery room after THA (CBC). Results. Drain utilization decreased by 50% and postoperative labs decreased by 70%. Drain and lab test cost per patient decreased from $74.62 before to $19.91 after the change, while charges per patient decreased from $625.23 before to $77.15 after. The 30 and 90-day readmission rates decreased with no readmissions occurring before or after the change that could have been prevented by using a drain or obtaining labs. Conclusion. Selective elimination of routine closed suction drainage and postoperative laboratory studies as part of an outpatient TJA protocol is safe and provides cost savings for inpatient primary TJA. Per 100 cases, this change could decrease institution costs by $5,500 and patient charges by $55,000 without decreasing quality or safety

Background. 80% of health data is recorded as free text and not easily accessible for use in research and QI. Natural Language Processing (NLP) could be used as a method to abstract data easier than manual methods. Our objectives were to investigate whether NLP can be used to abstract structured clinical data from notes for total joint arthroplasty (TJA). Methods. Clinical and hospital notes were collected for every patient undergoing a primary TJA. Human annotators reviewed a random training sample(n=400) and test sample(n=600) of notes from 6 different surgeons and manually abstracted historical, physical exam, operative, and outcomes data to create a gold standard dataset. Historical data collected included pain information and the various treatments tried (medications, injections, physical therapy). Physical exam information collected included ROM and the presence of deformity. Operative information included the angle of tibial slope, angle of tibial and femoral cuts, and patellar tracking for TKAs and approach and repair of external rotators for THAs. In addition, information on implant brand/type/size, sutures, and drains were collected for all TJAs. Finally, the occurrence of complications was collected. We then trained and tested our NLP system to automatically collect the respective variables. Finally, we assessed our automated approach by comparing system-generated findings against the gold standard. Results. Overall, the NLP algorithm performed well at abstracting all variables in our random test dataset (accuracy=96.3%, sensitivity=95.2%, specificity=97.4%). It performed better at abstracting historical information (accuracy=97.0%), physical exam information (accuracy=98.8%), and information on complications (accuracy=96.8%) compared to operative information (accuracy=94.8%), but it performed well with a sensitivity and specificity >90.0% for all variables. Discussion. The NLP system achieved good performance on a subset of randomly selected notes with querying information about TJA patients. Automated algorithms like the one developed here can help orthopedic practices collect information for registries and help guide QI without increased time-burden. For any tables or figures, please contact the authors directly

Aims

The purpose of our study is to summarise the current scientific findings regarding the impact of obesity on total hip arthroplasty (THA); specifically the influence of obesity on the timing of THA, incidence of complications, and effect on clinical and functional outcomes.

Louis Pasteur once said that: “Fortune favours the prepared mind.” As one of the great scientists who contributed to the fight against infection, he emphasised the importance of being prepared at all times to recognise infection and deal with it. Despite the many scientific discoveries and technological advances, such as the advent of antibiotics and the use of sterile techniques, infection continues to be a problem that haunts orthopaedic surgeons and inflicts suffering on patients.

The medical community has implemented many practices with the intention of preventing infection and treating it effectively when it occurs. Although high-level evidence may support some of these practices, many are based on little to no scientific foundation. Thus, around the world, there is great variation in practices for the prevention and management of periprosthetic joint infection.

This paper summaries the instigation, conduct and findings of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection.

Cite this article: Bone Joint J 2013;95-B:1450–2.